https://www.ajol.info/index.php/gmj/issue/feedGhana Medical Journal2019-01-14T16:23:43+02:00Prof David Ofori-Adjeigmj@dslghana.comOpen Journal SystemsArticles published in the Ghana Medical Journal may not be published elsewhere without the consent of the publishers. Request for consent for reproduction of material published in the Ghana Medical Journal should be addressed to the Editor-in-Chief. The publisher of this Journal reserves the right of copyright of all articles published in the Journal. It should also be understood by all authors that articles approved for publication in the journal are also deemed for publication online by the publisher.<p><em>The Ghana Medical Journal</em> is a peer-reviewed, open access journal published by the Ghana Medical Association. It was established in 1962 It publishes quality manuscripts in in all aspects of health, health care and the medical sciences. The full text of published articles are available online at this website and at African Journals Online ( AJOL) and PubMed Central ( PMC).</p><p>The Ghana Medical Journal is indexed in Medline, African Journals Online (AJOL), African Index Medicus, Scopus, EBSCO</p><p>Other websites related to this journal: <a title="http://www.ghanamedj.org/" href="http://www.ghanamedj.org/" target="_blank">http://www.ghanamedj.org/</a></p>https://www.ajol.info/index.php/gmj/article/view/181324Antimicrobial resistance: a clear and present danger in Ghana2019-01-14T16:23:42+02:00Appiah-Korang Labiguylabi2@gmail.comYaw Yaw Adjei Ofori-Adjeiguylabi2@gmail.com<p>The World Antibiotic Awareness Week (WAAW) is observed every year in November and is aimed at creating awareness of the increasing problem of antibiotic resistance.<br />The celebration is also to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.</p>https://www.ajol.info/index.php/gmj/article/view/181325Obituary - Frank K. Nyonator2019-01-14T16:23:43+02:00Koku Awoonor-Williams,koku.awoonor@ghsmail.orgJames F. Phillipsjfp2113@cumc.columbia.edu<p>The sudden death of Dr. Frank Kwadjo Nyonator on August 13, 2018 was a shock to his colleagues and the health sector in Ghana and abroad. At the time of his death, he was the Project Director of the USAID supported initiative of Management Systems International (MSI) that is known as Evaluate for Health (E4H). He took up this position after his retirement from the Ghana Health Service, where he spent most of his career in the public health system. He served at operational and leadership levels and rose through the ranks from medical officer,<br />Medical Superintendent, District Director of Health Services, Regional Director of Health Services, Director of Policy Planning Monitoring and Evaluation, and Acting Director General of the Ghana Health Services.</p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181326The female partners’ perspective on vasectomy in the central region of Ghana2019-01-14T16:23:43+02:00Joseph A. Adus.eliason@uccsms.edu.ghEugene K. M. Dartehs.eliason@uccsms.edu.ghDerek A. Tuoyires.eliason@uccsms.edu.ghSebastian Eliasons.eliason@uccsms.edu.gh<p><strong>Background</strong>: Vasectomy is one of the safest and inexpensive modern contraceptive methods but it remains relatively‘invisible’ in Ghana. Support of women may be a significant incentive in influencing their partners to adopt vasec- tomy.</p><p><strong>Objective</strong>: To examine the perspectives of women on vasectomy as a contraceptive option.</p><p><strong>Materials and Methods</strong>: A cross-sectional survey was conducted among 298 women accessing long-term or perma- nent family planning methods at health facilities in three selected districts in the Central Region of Ghana. Pearson’s Chi-square was used to test associations between variables and the attitudes of women towards vasectomy. A p-value of less than 0.05 was considered to be statistically significant<br /><strong></strong></p><p><strong>Results</strong>: Awareness of vasectomy was low (32%). About 66% of the women who became aware of vasectomy during the study would prefer their partners to go for vasectomy compared with 50% of those who were aware prior to the study. Women who would either not prefer vasectomy or support their partner’s choice of vasectomy cited fear of impotency (39.6%). There was a statistically significant association (p&lt;0.05) between ethnicity, previous contracep- tive use, awareness of male methods, and preference for vasectomy instead of bilateral tubal ligation (BTL). A statis- tically significant association (p&lt;0.05) was also found between age of participant, duration of marriage, religious affiliation, and the willingness of women to support their partner’s choice of vasectomy.<br /><strong></strong></p><p><strong>Conclusion</strong>: There is, therefore, the need for the involvement of women in the promotion of <br />vasectomy through vigorous publicity and education.</p><p><strong>Funding</strong>: By authors<br /><br /><strong>Keywords</strong>: vasectom , tubal, contraceptive agents, Ghana, sterilization</p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181327Knowledge, attitude and practice of progestin-only emergency contraceptives among female students of Jimma Teachers Training College, Jimma, Ethiopia2019-01-14T16:23:43+02:00Bahir K. A. Warrigudetatadesse@gmail.comTadesse G. Gurmugudetatadesse@gmail.com<p><strong>Background: </strong>Emergency contraception (EC) is the safest strategy for prevention of unintended<strong> </strong>pregnancy following unsafe sex provided that users have sufficient knowledge &amp; awareness of EC. </p><p><strong>Objective: </strong>The main objective of this study was to assess the knowledge, attitude, and practice of progestin-only emergency contraceptives.<strong> </strong></p><p><strong>Methods: </strong>Retrospective cross-sectional study was conducted from February 16 to April 18, 2017, among students of Jimma teacher’s training college. Chi-square test was run to identify the association between variables. Variables with the critical value P&lt;0.05 at CI of 95% were considered as statistically significant.</p><p align="left"><strong>Results: </strong>A total of 270 female students were involved in the study; of which 53.70% of them had knowledge about ECs. A significant association was found between knowledge on ECs &amp; age distribution (p&lt;0.001) and also the sexual activity of the participants (p=0.013).More than half of the respondents agreed that widespread use of ECs would increase the prevalence of HIV/ AIDS and other sexually transmitted diseases (STIs). Of the total study participants, 121 (44.81%) have used ECs and the utilization practice has a significant association with age distribution (p&lt;0.001 and religion of the study participants (p=0.002). </p><p><strong>Conclusion: </strong>Generally, nearly half of the study participants had knowledge about ECs and used EC at least once in their lifetime. Most of the students agreed that relying on EC pills and its accessibility would promote the spread of HIV/AIDS and STIs. </p><p align="left"> </p><p><strong>Funding:</strong> <strong>T</strong>he study was conducted with the financial support of Jimma University</p><p><strong>Keywords:</strong> Knowledge, emergency contraceptives, attitude, practice</p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181328Comprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-20162019-01-14T16:23:43+02:00Michael R. Adjeibonnahk10@gmail.comKwaku P. Asantebonnahk10@gmail.comJanet V. Baafibonnahk10@gmail.comTimothy S. Letsabonnahk10@gmail.com<p><strong>Background: </strong>Access to safe abortion services reduces incidence of unsafe abortion. However, other studies have documented negative impacts such as rise in sexually transmitted infections in jurisdictions with liberal abortion laws. </p><p><strong>Objective:</strong> We assessed the impact of Comprehensive Abortion Care (CAC) services on selected reproductive health indicators in the Tain district. </p><p><strong>Method:</strong> Aggregated service data on abortion, contraception (family planning), and delivery antenatal Human Immuno-deficiency Virus (HIV) infection status of women age 10-49 years were extracted from the District Health Information Management System version 2 (DHIMS-2) database for the period 2010 to 2016. Data were converted to rates using projected population figures from the Ghana Statistical Service and presented as tables and graph for trend analysis.</p><p><strong>Results:</strong> The proportion of unsafe abortion increased from 2010 to 2012 and declined from 2013 onwards with increasing proportions of women opting for safe induced abortions; while spontaneous abortions followed an incremental trend from 2010 to 2013; leveling out from 2014. The family planning acceptor rates stayed above 38% over the period. The total fertility rate (women age 10-14 inclusive) increased sequentially from 4.6/1000 women in 2010 to 89.4/1000 in 2016. The HIV infection prevalence were 2.2%, 3.7%, 3.4%, 3.8%, 2.5%, 2.3% and 2.7% for 2010 to 2016 respectively. </p><p><strong>Conclusion:</strong> Access to Comprehensive Abortion Care (CAC) services reduces the incidence of unsafe abortions. Improved access to contraception may not necessarily lead to a decline in abortion or fertility rates. Liberalizing abortion does lead to a rise in the prevalence of sexually transmitted infections (HIV).</p><p align="left"> </p><p><strong>Funding:</strong> No external funding received</p><p><strong>Keywords:</strong> unsafe abortion, comprehensive abortion care, Tain District, DHIMS 2.</p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181329Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania2019-01-14T16:23:43+02:00Sheillah Matinhuresmatinhure01@gmail.comMoses J. Chimbarismatinhure01@gmail.comMartin S Mapundasmatinhure01@gmail.com<div class="WordSection1"><p><strong>Objective:</strong> Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. <strong>Methods:</strong> A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package.</p><p><strong>Results:</strong> Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22).</p><p><strong>Conclusion:</strong> Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality.</p><p align="left"> </p><p><strong>Funding: </strong>College of Health Sciences of the University of KwaZulu-Natal<strong> </strong></p><p><strong>Keywords</strong>: Task sharing, skill mix, surgical equipment, assistant medical officers, infrastructure, caesarean sections, obstetric drugs and medical supplies</p></div>2018-12-18T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181330Indications for and the diagnostic yield of 24-hour Holter monitoring: a prospective study at the Korle Bu Teaching Hospital2019-01-14T16:23:43+02:00Alfred Dokuasiamahyeboah2006@yahoo.comTom A. Ndanuasiamahyeboah2006@yahoo.comBernard Y-A. Asareasiamahyeboah2006@yahoo.comCharles Antwi-Boasiako4asiamahyeboah2006@yahoo.comJohn Kpodonuasiamahyeboah2006@yahoo.com<p><strong>Background:</strong> Holter monitoring (HM) is an important tool used to evaluate symptoms suspected to be caused by arrhythmias. This study was aimed at determining the diagnostic yield of Holter monitoring among symptomatic and asymptomatic patients undergoing HM at the Korle-Bu Teaching Hospital.</p><p><strong>Methods: </strong>This was a prospective study among 400 consecutive symptomatic and asymptomatic patients undergoing HM from August 2006 to December, 2009 at the Korle-Bu Teaching Hospital. Data from the Holter study were analyzed, and symptoms linked to arrhythmias were evaluated to determine the diagnostic yield of HM in symptomatic and asymptomatic patients.<strong> </strong></p><p><strong>Results: </strong>The mean age of the patients was 51.81 ± 16 years. The most common indications (symptoms) for HM were palpitation (62.9%) and dizziness (34.0%); about half (53.3%) of the symptomatic patients had only one indication. Among the symptomatic group, 28 in 115 symptoms were linked to arrhythmias giving a diagnostic yield of 24.3% whereas in the asymptomatic group 1 in 33 of symptom was linked to arrhythmia giving a diagnostic yield of 3.0%. The study found an overall diagnostic yield of 19.6%.</p><p><strong>Conclusion: </strong>HM as a regular health check for the general population (asymptomatic cohorts) is not cost effective and does not provide significant data to influence care except when the subject is found to have symptoms.</p><p align="left"><strong>Funding:</strong> Funded by the Authors</p><p><strong>Keywords: </strong>arrhythmias, indications, Holter monitoring, diagnostic yield, Ghana<strong> </strong></p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181331Prevalence and risk factors for diabetic retinopathy in north-central Nigeria2019-01-14T16:23:43+02:00Rita O. Ewugakorexmed@yahoo.comOlukorede O. Adenugakorexmed@yahoo.comPatricia D. Wadekorexmed@yahoo.comJemimah O. Edahkorexmed@yahoo.com<div class="WordSection1"><p><strong>Background</strong>: To determine the prevalence, pattern and risk factors of Diabetic Retinopathy (DR) among patients with Diabetes Mellitus (DM) in a tertiary hospital in north-central Nigeria.</p><p><strong>Settings and Design: </strong>This was a hospital-based cross-sectional study conducted in Jos, north-central Nigeria. <strong>Materials and Methods:</strong> Consecutive adult patients with DM attending the endocrinology clinic who consented to the study were examined over a six-month period. Demographic data, duration of diabetes and history of any systemic disorder were obtained for each patient. A detailed ocular examination and fundus photography were performed and results of blood investigations such as Fasting Blood Glucose (FBG), Glycosylated Haemoglobin (HbA1c) and serum lipid profile were analysed. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0 software.</p><p><strong>Results:</strong> Three hundred and fifty-six patients were examined comprising of 120 (33.7%) males and 236 (66.3%) females giving a male to female ratio of 1:2. The mean age of the study population was 56.6 ± 12.3 years. Diabetic retinopathy and macular oedema were present in 66 (18.5%) and 51 (14.3%) patients respectively. Diabetes diagnosis of 10 years and above, FBG and HbA1c all had a statistically significant association with DR with p values &lt;0.001.</p><p><strong>Conclusion:</strong> The prevalence of DR was 18.5% in a hospital cohort of diabetic patients in north-central Nigeria with long duration of diabetes and poor glycaemic control being the major risk factors for retinopathy. These findings highlight the need for regular eye screening and good glycaemic control in individuals with diabetes in our environment. </p><p align="left"> </p><p><strong>Funding: </strong>None declared<strong> </strong></p><p><strong>Keywords:</strong><strong> </strong>Diabetic retinopathy, diabetes mellitus, macular oedema, prevalence, blindness</p></div>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181332Diabetic foot ulcer: risk factors among patients of a secondary healthcare facility in south west Nigeria2019-01-14T16:23:43+02:00Olatunde Odusantunsan2001@yahoo.comOlorunfemi E. Amorantunsan2001@yahoo.comOluwatoyin Salamitunsan2001@yahoo.com<p><strong>Background</strong>: Diabetic foot ulcer is a common long term complication of diabetes and the most common cause of non-traumatic amputation and prolonged hospitalization. These increases disease burden and further worsen quality of life.</p><p><strong>Aim</strong>: This study evaluated exposure risk factors for foot ulcers among diabetics attending a secondary healthcare facility in Southwest Nigeria.</p><p><strong>Methods</strong>: A case control study of exposure risk factors for diabetes foot ulcer (DFU) at General Hospital Marina Lagos. Using a structured interviewer administered questionnaire, information on foot care education, 24-hour dietary recall, medical history, anthropometric indices and social habits of participants were obtained and analyzed.</p><p><strong>Results</strong>: There were 636 participants in this study (106 cases and 530 controls) with median age of 61.1±11.0 years in both study groups and mostly females, (75.5% in cases and 78.7% controls) with female to male ratio of 3:1. Majority, (83% in cases and 85% in controls) were in the low socioeconomic class and had lived with DM for more than 5years. Of the studied risk factors, lacking foot care education, diagnosis of visual impairment and hypertension, dietary intake of large proportion of carbohydrate meal at breakfast and dinner and obesity occured in significantly higher proportion of cases and controls and were associated with presence of DFU. (p&lt;0.05) </p><p><strong>Conclusions</strong>: Lack of foot care education, diagnosis of visual impairment, hypertension and poor dietary habit are associated with presence of DFU. Addressing these factors from point of diagnosis will go a long way in stemming the burden of diabetes foot ulcer. </p><p align="left"> </p><p><strong>Funding: </strong>Self-funding.<strong> </strong></p><p><strong>Keywords:</strong> Diabetes, foot ulcer, exposure risk factors, Southwest Nigeria. </p>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181333Work-related musculoskeletal disorders among nurses and midwives at a municipal health facility in Ghana2019-01-14T16:23:43+02:00Hosea Boakyehoseaboakye@yahoo.comBridget Numarcehoseaboakye@yahoo.comJuliana O. Amehhoseaboakye@yahoo.comAjediran I. Bellohoseaboakye@yahoo.com<div class="WordSection1"><p><strong>Background:</strong> To determine the prevalence of work-related musculoskeletal disorders (WMSDs) among nurses and midwives, the associated job risk factors and the adopted coping strategies so as to provide baseline information in Ghana.</p><p><strong>Design</strong>: A cross-sectional study.</p><p><strong>Participants</strong>: One hundred and five (105) registered general nurses (RGN), 16 registered community health nurses (RCHN) and 13 registered midwives (RM) were purposively recruited for the study in Ledzokuku-Krowor Municipal (LEKMA) Hospital, in the Greater Accra Region of Ghana.</p><p> <strong>Interventions</strong>: An adapted self-administered questionnaire was used to obtain information regarding demographics, prevalence and pattern of WMSDs, associated job risk factors and the reported coping strategies commonly employed by the participants. Point- prevalence of WMSDs, coping strategies and risk factors were summarized with percentage. The prevalence was further analyzed with regression analysis to determine its correlation with BMI, age, years of experience and type of profession at p&lt;0.05 level of significance. </p><p><strong>Results: </strong>The 12-months prevalence was 79.0%, 53.8% and 18.8% for the RGN, RM, and RCHN respectively. Lifting or transferring of dependent patients 70(52.1%), inadequate training on injury prevention 63(46.5%) and working in awkward or cramped positions 53(39.6%) were the most perceived job risk factors. Forty-six (34.3%) participants commonly sought assistance from colleagues in handling heavy patients, 44(32.8%) modified their positions and 27(20.3%) modified their caring procedure as coping strategies.</p><p><strong>Conclusion: </strong> There was high point prevalence of self-reported WMSDs among the sampled nurses and midwives and lifting of patients was identified as the major risk factor. The findings have implication for body mechanics know-how of the nurses and midwives. </p><p align="left"> </p><p><strong>Funding:</strong> LEKMA Hospital<strong> </strong></p><p><strong>Keywords:</strong> Work-related musculoskeletal disorders, coping strategies, nursing, midwifery</p></div>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181334Accuracy of clinical diagnosis, mammography and ultrasonography in preoperative assessment of breast cancer2019-01-14T16:23:43+02:00Augustina Badu-Peprahaugustinabadupeprah@gmail.comYaw Adu-Sarkodieaugustinabadupeprah@gmail.com<div class="WordSection1"><p><strong>Background:</strong> Cancer of the breast is the most common malignancy affecting women in many parts of the world, hence its early detection has become necessary to reduce morbidity and mortality from the disease. In sub-Saharan Africa, radiological imaging, histology and management programs are associated with challenges. This study seeks to assess the validity of clinical diagnosis, mammography and breast ultrasonography in the preoperative assessment of suspected breast cancer patients for accurate detection of the disease to enable appropriate management.</p><p><strong>Methods:</strong> A prospective cross-sectional study was carried out in the Radiology Department of Komfo Anokye Teaching Hospital, Kumasi, Ghana, between November 2007 and July 2008 with a sample size of 103. All patients with a clinical suspicion of breast cancer who gave informed consent were recruited, underwent bilateral mammography and whole breast ultrasonography and then biopsy for all BI-RADS categories 4 or 5 lesions. The histopathology results were retrieved to complete the study.</p><p><strong>Result:</strong> In this study the definition of malignancy was made using histology as the gold standard. A total of 103 patients were recruited for this study with mean age of 55(<span style="text-decoration: underline;">+</span>15) years, out of which 52 (50.5%) had malignant lesions. The overall sensitivity of clinical diagnosis was 50.5%. While the overall sensitivity and specificity for mammogram and ultrasound were 73.0%, 80.0% and 100% ,80.4% respectively. </p><p><strong>Conclusion:</strong> In conclusion, this study has demonstrated that clinical diagnosis, ultrasound and mammography can potentially predict breast cancer disease with considerable sensitivity and specificity.</p><p align="left"> </p><p><strong>Funding: </strong>None declared</p><p><strong>Keywords: </strong>Mammography, ultrasonography, histology, breast cancer.</p></div>2018-12-28T00:00:00+02:00https://www.ajol.info/index.php/gmj/article/view/181335Thyroid scintigraphy in the management of benign thyroid disease2019-01-14T16:23:43+02:00Yaw A. Amoakoyamoako2002@yahoo.co.ukEmmanuel N.B Hammondyamoako2002@yahoo.co.ukAwo Assasie-Gyimahyamoako2002@yahoo.co.ukOsei Sarfo-Kantankayamoako2002@yahoo.co.uk<div class="WordSection1"><p>Thyrotoxicosis as a clinical entity has varied aetiologies. Accurate distinction of the underlying aetiology is important to guide therapy. Clinical findings are not always accurate in identifying the underlying aetiology. There is considerable overlap between the various aetiologies when using serum T3/T4 ratio. Although ultrasound is widely available and has reasonable sensitivity, it is operator dependent and misses many cases of early Grave's disease. 99mTc scintigraphy is a simple and accurate modality for assessing the functional status of the thyroid gland and delineating the aetiology of thyrotoxicosis. This paper seeks to inform on the use of thyroid scintigraphy in the management of benign thyroid disorders.</p><p align="left"> </p><p><strong>Funding: </strong>None<strong> </strong></p><p><strong>Keywords:</strong> Scintigraphy, thyroid gland, functional imaging, Grave’s disease, Ghana</p></div>2018-12-28T00:00:00+02:00